DOSAGE ADJUSTMENTS IN CKD
Many drugs are prescribed by doctors for various disease to the patients for treatments.The general rule is there should be a special care to be taken by the doctors to old and Chronic Kidney Disease (CKD) patients who's kidneys are very weak and functionless respectively.
Kidneys are one of the major organs eliminating the unwanted materials from the body and regulating the amount of bioavailability and plasma concentration of a drug.A diseased kidney which last its power of excretion may cause over accumulation of certain drugs in our blood and body fluids which results in toxicity.
A diseased kidney may over eliminate certain drugs which causes insufficient bioavailability and under plasma concentration which result in poor or nill therapeutic effect at the given dosage.
Hence dosage adjustments are necessary by accurate technical assessments by the doctors.
The following news study is more informative for you.
The following medications require dosage adjutments in CKD
1.Allopurinol
2.Lithium
3.Acyclovir
4.Amantadine
5.Fexofenadine
6.Gabapentin
7.Metoclopramide
8.Ranitidine
Antimicrobials that require dosage adjustments in CKD
1.Cephalexin
2.Amoxicillin
3.Cefuroxime
4.Ciprofloxacin
5.Clarithromycin
6.Levofloxacin
7.Nitrofurantoin
8.Piperacillin
9.Tetracyclin
10.Trimethoprim+sulphamethoxazole
The following medications require dosage adjutments in CKD
1.Allopurinol
2.Lithium
3.Acyclovir
4.Amantadine
5.Fexofenadine
6.Gabapentin
7.Metoclopramide
8.Ranitidine
Antimicrobials that require dosage adjustments in CKD
1.Cephalexin
2.Amoxicillin
3.Cefuroxime
4.Ciprofloxacin
5.Clarithromycin
6.Levofloxacin
7.Nitrofurantoin
8.Piperacillin
9.Tetracyclin
10.Trimethoprim+sulphamethoxazole
The News:-
Medications Requiring Renal Dosage Adjustments
Published Online: Wednesday, August 17, 2016
Chronic kidney disease (CKD) and renal
dysfunction can alter medications’ renal elimination and lead to
subtherapeutic or supratherapeutic drug concentrations, which may
decrease efficacy or increase toxicity.
Using the Cockroft-Gault equation or the Modification of Diet in Renal Disease (MDRD) to estimate creatinine clearance (CrCl) helps provide the appropriate dosage of renally-excreted medications.1 Because elderly patients tend to have poor renal function, it’s important to take CrCl into consideration when dosing medications that follow renal elimination.
Renal damage can alter clearance of active drug metabolites, potentially causing accumulation.2 Altered renal function can also affect dosing intervals of renally-eliminated medications.
The following medications require renal dosage adjustments3,4:
Some common antimicrobials requiring renal dosing include3:
Roughly half of adults 30 to 64 years old are expected to develop CKD in their lifetime.5 In patients with a glomerular filtration rate (GFR) <60 m="" min="" ml="" sup="">2
Using the Cockroft-Gault equation or the Modification of Diet in Renal Disease (MDRD) to estimate creatinine clearance (CrCl) helps provide the appropriate dosage of renally-excreted medications.1 Because elderly patients tend to have poor renal function, it’s important to take CrCl into consideration when dosing medications that follow renal elimination.
Renal damage can alter clearance of active drug metabolites, potentially causing accumulation.2 Altered renal function can also affect dosing intervals of renally-eliminated medications.
The following medications require renal dosage adjustments3,4:
- Allopurinol (Zyloprim)
- Lithium (Lithobid)
- Acyclovir (Valtrex)
- Amantadine (Symmetrel)
- Fexofenadine (Allegra)
- Gabapentin (Neurontin)
- Metoclopramide (Reglan)
- Ranitidine (Zantac)
- Rivaroxaban (Xarelto)
- Fesoterodine (Toviaz)
Some common antimicrobials requiring renal dosing include3:
- Cephalexin (Keflex)
- Amoxicillin (Amoxil)
- Cefuroxime (Ceftin)
- Ciprofloxacin (Cipro)
- Clarithromycin (Biaxin)
- Levofloxacin (Levaquin)
- Nitrofurantoin (Macrobid)
- Piperacillin/Tazobactam (Zosyn)
- Tetracycline (Sumycin)
- Trimethoprim/Sulfamethoxazole (Bactrim)
Roughly half of adults 30 to 64 years old are expected to develop CKD in their lifetime.5 In patients with a glomerular filtration rate (GFR) <60 m="" min="" ml="" sup="">2
CKD patients will require dosage adjustments for certain medications, including antihypertensives, hypoglycemic agents, analgesics, statins. Staging of CKD is dependent on the patient’s GFR results.
Diuretics
Thiazide diuretics are considered first-line treatment for patients with uncomplicated hypertension and CKD (only if Scr <2 .5="" crcl="" dl="" mg="" or="">30 mL/min). Loop diuretics are also commonly used to treat uncomplicated hypertension in CKD patients, but potassium-sparing diuretics should be avoided because the mechanism through which they work (excreting extra fluids and retaining potassium) is detrimental to the health of these patients.1
Antihypertensives
Angiotensin-converting enzyme inhibitors and angiotensin receptor blockers are first-line antihypertensives used in patients with type 1 or 2 diabetes and early CKD.1 Beta-blockers that are hydrophilic (including atenolol, bisoprolol, and nadolol) require dosing adjustments in CKD patients.
Hypoglycemic Agents
A renally-excreted hypoglycemic agent like metformin isn’t recommended if Scr is >1.5 mg/dL in men or >1.4 mg/dL in women. It’s important to monitor CKD patients on metformin closely for lactic acidosis development. Sulfonylureas like chlorpropamide and glyburide should be avoided in patients with stage 3 to 5 CKD,1 as their use increases hypoglycemia risk.
Analgesics
Metabolites of morphine, tramadol, and codeine can accumulate in CKD patients, leading to respiratory adverse effects. Dosage reduction is recommended for morphine and codeine in patients with CrCl <50 accumulation="" and="" be="" br="" can="" cause="" ckd="" concentrations="" dosing="" for="" harm.="" in="" intervals="" lead="" may="" metabolite="" min.="" ml="" modified="" need="" opioids="" patients.="" severe="" supratherapeutic="" to="">
Statins
Statin therapy for dyslipidemia is commonly used in CKD patients. Atorvastatin and pravastatin have no dose adjustment recommendation in these patients,6 but rosuvastatin, simvastatin, and lovastatin do have dose adjustment recommendations dependent on CKD severity. Fluvastatin should be used with caution in CKD patients.
Taking renal function into consideration when necessary can help ensure optimal therapy. Considering CrCl and GFR may prevent unnecessary adverse effects from medications that require renal dosage adjustments.
References
1. Munar MY, et al. Drug dosing adjustments in patients with chronic kidney disease. American Academy of Fam Physicians. aafp.org/afp/2007/0515/p1487.pdf. Accessed August 10, 2016.
2. Doogue MP, et al. Drug dosing in renal disease. Clin Biochem. 2011;32:69-73.
3. Renal dosing - database. GlobalRPh. globalrph.com/index_renal.htm. Accessed August 13, 2016.
4. Renal dosage adjustment guidelines for antimicrobials. Nebraska Medicine. nebraskamed.com/app_files/pdf/careers/education-programs/asp/antimicrobial-renal-dosing-guidelines.pdf. Updated March 2013. Accessed August 10, 2016.
5. CDC. Chronic kidney disease (CKD) surveillance system. nccd.cdc.gov/ckd/. Updated June 23, 2016. Accessed August 13, 2016.
6. Clinical Practice Guidelines and Clinical Practice Recommendations for Diabetes and Chronic Kidney Disease. National Kidney Foundation. kidney.org/professionals/KDOQI/guideline_diabetes. Accessed August 13, 2016.
